PDF(Pubmed)
Abstract：
Background: Modern treatments for transfusion-dependent β-thalassemia (TDβT) have allowed patients to reach high life expectancy with no iron overload. Despite survival improvement, atrial fibrillation (AF) has emerged as a relevant issue. AF pathophysiology and characteristics in TDβT are different than in the general population. Epicardial adipose tissue (EAT) may play a role but its relationship with AF in patients with TDβT has not been explored. Methods: A monocentric, cross-sectional study, enrolling consecutive patients with TDβT. Epicardial adipose tissue (EAT) was evaluated at magnetic resonance. Characteristics of patients with and without history of AF were investigated. Factors independently associated with AF prevalence were analyzed. Results: A total of 116 patients were enrolled. All patients were treated with regular chelation therapy. The prevalence of AF was 29.3% (34/116). Cardiac T2* and liver iron concentration were no different between patients with and without AF. EAT thickness was significantly higher in patients with AF at left atrium, right atrium and right ventricle (5.0 vs. 4.0 mm, p < 0.01, 4.4 vs. 4.0, p = 0.02 and 5.0 vs. 4.3, p = 0.04). Patients with AF presented with older age, (53 vs. 49 years, p < 0.01), more hypothyroidism (44.1 vs. 20.7%, p = 0.01), pulmonary hypertension (23.5 vs. 2.4% p < 0.01), splenectomy (88.2 vs. 64.6%, p = 0.01), higher right and left atrial volume (61 vs. 40 and 74 vs. 43 mL, both p < 0.01). At multivariable analysis, hypothyroidism, left atrial volume and left atrial EAT were independently associated with AF (odds ratio 9.95, 1.09 and 1.91, respectively). Conclusions: In a contemporary cohort of patients with TDβT, treated with regular chelation therapy, prevalence of AF was unrelated to iron overload. EAT was independently associated with AF.
摘要：
背景：输血依赖性β地中海贫血（TDβT）的现代治疗方法使患者在没有铁过载的情况下达到了较高的预期寿命。尽管生存有所改善，心房颤动（AF）已成为相关问题。TDβT的AF病理生理学和特征与普通人群不同。心外膜脂肪组织（EAT）可能起作用，但尚未探讨其与TDβT患者AF的关系。方法：单中心，横断面研究，连续招募TDβT患者。磁共振评估心外膜脂肪组织（EAT）。研究了有和没有房颤史的患者的特征。分析与房颤患病率相关的独立因素。结果：共纳入116例患者。所有患者均接受常规螯合治疗。房颤患病率为29.3%(34/116)。有和没有AF的患者之间的心脏T2*和肝脏铁浓度没有差异。房颤患者左心房EAT厚度明显增高，右心房和右心室（5.0vs.4.0mm,p<0.01,4.4vs.4.0，p=0.02和5.0与4.3，p=0.04）。房颤患者年龄较大，（53vs.49年,p<0.01),更多甲状腺功能减退（44.1vs.20.7%,p=0.01),肺动脉高压（23.5vs.2.4%p<0.01)，脾切除术（88.2vs.64.6%,p=0.01),右心房和左心房容积较高(61vs.40和74vs.43mL,两者p<0.01)。在多变量分析中，甲状腺功能减退,左心房容积和左心房EAT与房颤独立相关(比值比分别为9.95,1.09和1.91).结论：在TDβT患者的当代队列中，用常规的螯合疗法治疗，房颤的患病率与铁超负荷无关.EAT与房颤独立相关。
